A clinicopathological study on acute cutaneous lesions induced by sulfur mustard gas (yperite)

During the Iran-Iraq war (1980-1988), sulfur mustard (as a chemical warfare agent) was launched on several occasions. Thirty-two victims with acute mustard poisoning were referred to our dermatology department, and are basis of this clinicopathologic study. Clinical and laboratory findings of these 32 adult patients exposed to mustard gas were determined. Skin biopsies were obtained from all of the patients and studied after staining of the specimens with routine and special stains. Clinically the most frequently involved areas were genitalia, face and axilla. The most common cutaneous findings were erosions, erythema and hyperpigmentation. The histopathologic changes of skin induced by mustard gas, included four distinct patterns: 1. Interface dermatitis, vacuolar type and lichenoid type; 2. Spongiotic dermatitis and bullous dermatitis (with or without acantholysis); 3. Pigmentary disorder pattern, increase of epidermal melanization. 4. Alteration of dermis/hypodermis, sclerodermoid pattern, vasculopathy and appendageal inflammatory response. Despite some specific characteristics related to sulfur mustard effect, these findings were compatible with histopathological changes of the chemical burns.